Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011-2017.

Objectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states' immunization exemption laws.Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination.Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states.Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one's children from vaccination persist despite vaccine hesitancy, which is encouraging for public health.Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public's health. There is a need for constituents to engage their elected legislators and advocate provaccination policies.

Towards Eliminating Nonmedical Vaccination Exemptions Among School-Age Children.

The increase in childhood vaccine hesitancy and corresponding use of nonmedical exemptions to abstain from vaccination has deleteriously impacted the public's health. This has many in the field calling for widespread elimination of nonmedical school-entry exemptions, as has been done in six states to date: West Virginia, Mississippi, California, New York, Maine, and Connecticut. By eliminating nonmedical exemptions, vaccination rates can be improved, with the corresponding decline in vaccine-preventable disease incidence. Yet the path towards widespread adoption of these policies presents legislative and judicial implications which evolve with the changing political landscape. In this this article, we discuss legislative actions concerning the expansion of exemptions, whether the widespread elimination of nonmedical exemptions would be effective from a practical and legal end, and how the COVID-19 pandemic has influenced such legislation, with specific focus on Delaware.

Application of state law in the public health emergency response to COVID-19: an example from Delaware in the United States.

The unprecedented COVID-19 pandemic of 2019-2020 generated an equally unprecedented response from government institutions to control contagion. These legal responses included shelter in place orders, closure of non-essential businesses, limiting public gatherings, and mandatory mask wearing, among others. The State of Delaware in the United States experienced an outbreak later than most states but a particularly intense one that required a rapid and effective public health response. We describe the ways that Delaware responded through the interplay of public health, law, and government action, contrasting the state to others. We discuss how evolution of this state's public heath legal response to the pandemic can inform future disease outbreak policies.

The heterogeneous effect of marijuana decriminalization policy on arrest rates in Philadelphia, Pennsylvania, 2009-2018.

BACKGROUND: Marijuana decriminalization holds potential to reduce health inequities. However, limited attention has focused on assessing the impact of decriminalization policies across different populations. This study aims to determine the differential effect of a marijuana decriminalization policy change in Philadelphia, PA on marijuana arrests by demographic characteristics. METHODS: Using a comparative interrupted time series design, we assessed whether the onset of marijuana decriminalization in Philadelphia County was associated with reduction in arrests rates from 2009 to 2018 compared to Dauphin County. Stratified models were used to describe the differential impact of decriminalization across different demographic populations. RESULTS: Compared to Dauphin, the mean arrest rate for all marijuana-related crimes in Philadelphia declined by 19.9 per 100,000 residents (34.9% reduction), 17.1 per 100,000 residents (43.1% reduction) for possession, and 2.8 per 100,000 resident (15.9% reduction) for sales/manufacturing. Arrest rates also differed by demographic characteristics post-decriminalization. Notably, African Americans had a greater absolute/relative reduction in possession-based arrests than Whites. However, relative reductions for sales/manufacturing-based arrests was nearly 3 times lower for African Americans. Males had greater absolute/relative reduction for possession-based arrests, but lower relative reduction for sales/manufacturing-based arrests compared to females. There were no substantial absolute differences by age; however, youths (vs. adults) experienced higher relative reduction in arrest rates. CONCLUSIONS: Findings suggest an absolute/relative reduction for possession-based arrests post-decriminalization; however, relative disparities in sales/manufacturing-based arrests, specifically for African Americans, increased. More consideration towards the heterogeneous effect of marijuana decriminalization are needed given the unintended harmful effects of arrest on already vulnerable populations.

Low Incidence and High Profile: Tuberculosis Control in Delaware.

Tuberculosis (TB) is an infectious disease of global burden. While Delaware has low incidence of active TB compared to other locales, because of its small size these few cases tend to garner widespread attention. In this article, a study of one such case of active TB is presented. This case serves as a didactic example of the public health response to the complexities of treatment, including institutional, transient settings, and patient refusal. This consequently led to ordered directly observed therapy of the individual. The article concludes with a discussion of the law and legal implications for such cases in Delaware.